Artikel
Factors predicting poor outcome from discharge to one year after subarachnoid hemorrhage. The Swiss Study on Subarachnoid Hemorrhage (Swiss SOS)
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Veröffentlicht: | 9. Juni 2017 |
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Objective: Predictors of poor outcome after subarachnoid hemorrhage have been amply delineated previously. However, data on factors predicting further long-term recovery for patients discharged in a dependent state are scarce.
Methods: The Swiss study on subarachnoid hemorrhage (Swiss SOS) includes all patients treated for SAH since 1st of January 2009 in all eight neurovascular centers in Switzerland. Poor outcome was defined as a modified Rankin scale 3-5, excluding mortality. We analyzed predictors leading to a lack of improvement from dependent to dependent state using multivariate binary logistic regression with a significance level below 0.05.
Results: 1234 surviving patients matched the inclusion criteria for the present analysis. At discharge, 797 patients (64.6%) were reported as independent, while 437 (35.4%) were dependent. At one year, 1050 patients (85.1%) were independent compared to 184 patients with dependent survival (14.9%). 265/437 patients (60.6%) improved from a dependent state at discharge to independent function at one year. Multivariate analysis identified the following factors to be inversely associated with improvement from discharge to one year: Poor WFNS (3-5) (OR 1.89; CI95% 1.36-2.63, p<0.001), high Fisher grade (3,4) (OR 2.04; CI95% 1.08-3.85; p=0.03), chronic hydrocephalus (OR 1.50; CI95% 1.06-2.13; p=0.02) and delayed cerebral ischemia (OR 1.62; CI95% 1.17-2.23; p=0.003).
Conclusion: A majority of patients who are discharged in a dependent state after SAH will regain independent function at one year. Chronic hydrocephalus and delayed cerebral ischemia are the main potentially modifiable variables affecting long-term outcome.